Ketogenic Diet FAQ: All You Need to Know

KetoDiet Basic Facts

Why is it that conventional diets don’t work?

Most of us would say we get fat simply because we get lazy and eat more. But what if it’s the other way round? What if we just get fat and as a result we eat more and become lazy?

For the last decades we have been given wrong advice about nutrition and effects of fatty foods on putting on weight. What if the main problem is that due to our modern diets we cannot satisfy our appetite? A study on this subject concluded with a surprising result: the fatter people get, the more inactive they become, not the other way round. And what if the interests of the authorities offering advice are influenced by economic reasons? To learn more about this, I recommend you watch The Food Revolution on Youtube

Ketogenic diets are, in fact, closely related to the Paleolithic diet. Both exclude carbohydrates and aim at eating real food. Today carbohydrates make the majority of our diet and have significant implications for our health including hormone balance. For example, insulin, which is responsible for storing fat in our body, is greatly affected by excessive carbohydrate consumption. Carbohydrates are without doubt the most fattening element in our diets.

Based on studies performed over the last decades, calorie-restricted diets or diets restricted in fat generally have an insignificant effect on our long-term weight loss. These types of diets are virtually ineffective for the vast majority of people. As concluded in Dr. John Briffa’s book, Escape the Diet Trap: In studies, low-carbohydrate diets in which individuals eat as much as they like consistently outperform low-fat, calorie-restricted ones for weight loss. A systematic review of clinical trials on the health effects of low carbohydrate diets from 2012 shows that low carb diets show significant decrease in body weight and an improvement of all major risk factors for heart disease.

Another benefit of ketogenic diets is the individual’s ability to build and preserve muscle tissue rather than losing it. When you follow a high carbohydrate (i.e. low-fat, reduced-calorie) diet, only some of your body fat is burned during weight loss. Unfortunately, on such diets your body will use the protein stores (muscles) and convert them to glucose for energy rather than use fat stores. This is, of course, an unfavorable effect, as you lose significant muscle tissue instead of fat.

How is weight loss achieved on ketogenic diets?

This is probably the most commonly asked question, as many people are concerned about the real effects of ketosis. Does ketosis work? There are three main effects of low-carb diets which I have covered in this post.

Do I need to measure ketones?

If you are new to the diet, it will help if you daily test your ketone levels. Once you get keto-adapted and you fully understand ketogenic eating, you won’t need you test your ketone levels every day. Although it depends on individual needs and goals, weekly testing should be sufficient for most people. If you want to learn all about ketone testing, have a look at this post: Ketosis & Measuring Ketones.

What is the difference between a low-carbohydrate diet and a ketogenic diet?

Ketogenic diets are a subset of low carbohydrate diets. It is generally accepted, that any diet below 130-150 grams of carbohydrates is regarded as low-carb. Ketogenic diets induce a metabolic state known as ketosis, which is usually achieved at a level of about 50 grams of carbohydrates a day (20-30 grams of net carbs) or less. The exact amount is individual and may vary. In this post I’ve explained how to find out your net carbs limit.

Do you need to be in ketosis to lose weight? Not necessarily. You can lose weight without being in ketosis. Food high in fat, adequate in protein and low in carbohydrates is sating, making you less hungry and, therefore, you’ll be experiencing less food cravings. Research on this subject has shown that carbohydrates are the least sating, while protein and fat the most sating nutrients.

What is insulin and what does it do?

Insulin is one of the most important hormones. It is secreted by the pancreas and is what ketogenic diets mostly focus on, as it affects body fat and metabolism of carbohydrates. It is effectivelly a storage hormone, responsible for moving nutrients out of the blood stream and into target tissues. Its other job is to regulate your blood sugar level.

As you eat carbohydrates, your body must produce more insulin to keep up with increased levels of glucose in your body. In some cases, this eventually leads to insulin resistance, and then Type 2 diabetes. This may often go along with high LDL cholesterol (“bad”), low HDL cholesterol (“good”), higher triglyceride levels and increased inflammation.

When you eat less carbs, less insulin is required to be secreted into your bloodstream and regulate your blood sugar and as a result, less fat storage.

Here is a great video in which Jennifer Elliott, a registered dietitian, explains the role and effects of insulin in our body: Tired, Moody and Overweight?

Do I need to count calories? Do calories matter?

It’s a common misconception that you can eat unlimited amount of calories and still lose weight. Although this doesn’t happen often, you can put on weight even on a low-carb diet.

Low-carb ketogenic diets are naturally sating and act as appetite suppressants. This is why you’ll eat less and won’t need to count calories which is one of the main effects of the ketogenic diet.

However, if for any reason your weight is stalling for more than 2-3 weeks, you may need to consider keeping an eye on your energy intake (calories). Reaching a weight loss plateau may be caused by several factors and you don’t necessarily have to be eating too much, in fact, you may discover that you haven’t been eating enough. In my experience, losing body fat becomes more and more difficult as you get close to your target weight.

To make it easy for you to calculate your ideal macronutrients on a ketogenic diet, we developed a free online keto calculator, KetoDiet Buddy – try it now! As always, I recommend you follow the “slow” or “moderate” fat loss path.

How do I track my macros / my carb intake?

Together with my partner, we have developed an app specifically for this purpose. The KetoDiet iPad app can track your macronutrients, electrolytes and help you achieve your goals – whether it’s losing weight or simply eating real food! Although the tracking feature is currently only available on the iPad, we have been working on a universal app and you’ll soon be able to use this feature on the iPhone. Keep in mind that the current iPhone app only includes recipes & guide to keto. The planner is not a part of KetoDiet Basic for the iPhone. You can learn more about the apps and our future plans in this post: KetoDiet App FAQ

KetoDiet app - Progress monitoring

How long does it take to get to ketosis?

It usually takes 2-3 days to enter ketosis if you keep within your optimal net carbs limit. You can speed this process up by exercising to accelerate the depletion of glycogen in your body. If you are quite sedentary, it may take up to a week based on experience. Once you stick to the plan, it’s actually easy to get into ketosis, as you will find out using ketone detection strips or blood ketone meter.

What is keto-adaptation?

Keto adaptation occurs when shifting the body away from glucose and towards fat metabolism. The adaptations to ketosis are complex and involve most systems of the body. The major adaptations occur in the body’s tissues, especially the brain, liver, kidney and muscles (Lyle McDonald, The Ketogenic Diet, chapter 5, 1998).

As I have mentioned before, it’s usually easy to get into ketosis, but may be more difficult to get keto-adapted. Keto-adaptation is for people who are serious about eating well and take the low-carb approach as a lifestyle rather than a short-term solution to weight loss. It may take 3-4 weeks or even months before your body learns how to use ketones effectively. You can read more about keto-adaptation in Dr Volek and Dr Phinney’s books: The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance

How often and how much should I eat?

With ever increasing consumption of carbs and sugar, people have become “immune” to their body signals and tempt to eat more than they need. Conventional wisdom also tells us to eat regularly, in small portions in order to avoid being hungry and eventually eating too much. However, the best approach is not to eat every 2-3 hours, but to eat whenever you start feeling hungry but not ravenous. You should have a small snack with you in case you have no time for a regular meal. Such a snack could be a handful of nuts, piece of dark chocolate (at least 70% cocoa), avocado or low-carb fruit such as berries.

Try to eat slowly and avoid any other activity while eating. You will gradually regain the ability to recognise when you’ve had enough. There is no reason to clear the plate completely if you feel full. It’s your health and there is nothing wrong about that.

Remember: Eat when you are hungry, even if it’s a meal a day. Don’t let others dictate what you eat or how often you should eat. If you don’t need to snack, avoid snacking.

How much weight could I lose and how fast?

This is again individual and can vary from 1 to 5 lbs (0.5 to 2.5 Kg) per week. It depends on the speed of your metabolism, age, and fitness level, etc. Again, concentrate on your body fat percentage rather than your weight, as it says nothing about your body composition. Use a tape measure – this says more than just numbers on scales.

There are critics claiming that all the weight you lose within the first week or two is just water. That’s true. However, this is just a natural process, as your body loses glycogen during the first few days. There is nothing wrong about it. The reason is that one molecule of glycogen usually attracts four molecules of water and as a result of it, when your body gets rid of glycogen, it also exerts water. Don’t panic, after you have no storage of glycogen, the process of ketosis starts and you lose fat (Eades, M., The Protein Power Lifeplan, 1995). Just remember – drink plenty of water; you will most likely have to drink more than you were used to.

You can actually lose weight without being in ketosis. The reason is that you generally eat more nutritious and filling food that may help you lose weight. Studies show (study 1, study 2) that people eating food rich in protein and fat rather than carbohydrates eat less, as protein and fat are more sating nutrients. Therefore, most people who are severely overweight see great results on any low-carb diet – not necessarily ketogenic diet. It’s more difficult to lose body fat when the desired weight loss is as little as 5-10 pounds. In such cases, you have to be more disciplined. Some problems could arise when an individual has been through many types of “traditional” diets, causing yoyo effects and badly affecting their metabolism and hormone balance.

Here are the phases of a ketogenic diet:

1. Initial fast weight loss – induction phase
Most of the first few days of weight loss will come from water. It doesn’t have to be dramatic; everybody may react in a different way.

2. Post-induction Stall Syndrome
A new balance of water and glycogen will be set. This may cause stalling or even slight weight gain. Don’t panic, this is just water and won’t last for long, probably just a few days.

3. Keto-adaptation
People get keto-adapted after a few weeks (3-4 weeks on average). Full keto-adaptation, where the body has learnt to use fat for fuel and your brain has switched from using glycogen to ketones, may take even months. Your weight may stall or even fluctuate, but the overall trend of your weight should be downwards. If your weight is stalling, use some tips in this post.

What is intermittent fasting?

Just like Fat Fasting (guide is here), Intermittent Fasting (IF) is a type of diet approach that is often used for breaking though a stubborn month-lasting weight loss plateau. Intermittent Fasting is not used just for weight loss – it has proven to have myriad health benefits in the long term. You can read more about IF in my post here: Complete Guide to Intermittent Fasting

What is fat fasting?

It is another type of fasting where you eat about 90% of your calorie intake from fat while also keeping your calorie intake low, up to 1000-1200 kcal a day. The fat fast should not last for more than a few days. To learn more about fat fasting, have a look at this guide.

Which books and resources do you recommend?

Here is a list of books focused on low-carb, keto & paleo nutrition including cookbooks (my Amazon store). Here is a list of useful video presentations from experts like Dr Volek, Dr Phinney, Dr Lustig and many others. Lastly, here is a list of online resources such as communities, websites and blogs I follow and highly recommend.

Foods & Diet Plans

Where can I find low-carb, paleo recipes?

I have hundreds of recipes on my blog. If you have any preferences or/and any dietary restrictions, simply use use the filtering. Even more delicious low-carb recipes are found in the KetoDiet Apps.

Where can I find a keto / paleo diet plans?

I’ve created several free diet plans including a diet plan for the fat fast. You can get them as free eBooks here!

What should I eat?

I have a list of foods suitable for the ketogenic diet listed in this post: Complete Keto Diet Food List: What to Eat and Avoid and even more information here: Practical Guide to Keto & Paleo Diet for Optimal Health and Long-Term Weight Loss Both include a PDF version!

Can I eat nuts?

Yes you can, in moderation. Nuts are low in net carbs and suitable for the ketogenic diet. Even if you count total carbs (rather than net carbs), nuts are high in insoluble fibre from which we cannot derive any calories and has zero effect on blood sugar. The reason some people do better without nuts and full-fat dairy is because these foods are calorie-dense and easy to overeat, not because they are high in carbs. You can read more about Total vs Net carbs here.

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Can I eat dairy?

Yes, you can eat dairy in moderation. Apart from milk, it’s a myth that raw dairy is high in carbs. Unless you are dairy intolerant or allergic to lactose or casein, foods like cream, butter, yogurt and cheese can be included in your diet.

Can I eat fruit?

Yes, you can eat avocados, coconut and moderate amounts of low-carb fruits such as berries. Tomatoes which are technically a fruit can also be eaten in moderation.

Which sweeteners can I use?

You can have sweeteners even on a LCHF diet. Ideally, use Erythritol or Stevia. For the full list of suitable sweeteners and sweeteners to avoid, check out my post here: Complete Guide to Sweeteners

Can I drink coffee, black tea and eat dark chocolate? How about caffein?

In general, you can enjoy these foods in moderation on the keto diet. The effects of caffeine are a matter of dispute. Some keto-dieters claim that caffeine puts them out of ketosis, increases cortisol levels and prevents keto-adaptation. On the other hand, caffeine may help you kick-start fat loss and control your appetite. It’s also commonly advised to drink coffee right before exercise. There is no conclusive evidence for the effects of caffeine, and it may well be down to individual responses – I’ve been drinking coffee for over 15 years and have no issues with cortisol levels or inflammation (CRP levels). If you drink coffee, forget using sugar and milk. Instead, use some cream and if needed, “zero-carb” sweeteners.

Can I drink alcohol on keto?

Not during the first few months. Although pure alcohol doesn’t contain carbs, drinking alcohol will slow down weight loss. Even if there is no sugar, your body can’t store alcohol as fat – it has to metabolise it. This means that it will utilise alcohol instead of body fat. I’ve written more about alcohol on keto in this post.

Are fermented foods allowed?

Raw fermented foods such as sauerkraut, kombucha, kimchi, kefir (dairy or coconut) or raw full-fat plain yogurt are packed with probiotics, vitamins and enzymes. If you eat these on a regular basis, they will help your digestion, restore proper balance of bacteria in your gut and improve overall immunity. Finally, eating fermented foods low in carbs will help you lose weight!

Raw, plain, full-fat yogurt is one of the most confusing foods when it comes to carbs. You actually don’t need to count the whole carb content, as the bacteria in yogurt eat up much of the lactose content and thus reducing the amount of carbs in the final product. According to Dr. Jack Goldberg, co-author of the GO-diet, under ideal circumstances, bacterial activity reduces the carbs content to about 30%. Such products have to be labeled “contains live cultures” such as lactobacillus acidophilus, bifidus, or l. casei. Another factor that affects the carb count is whether the yogurt has fermented under ideal conditions and for sufficient amount of time. The issue is that most commercially available yogurts don’t ferment long enough and the carb content only decreases to about 60%. If you leave if for longer, the fermentation will continue even after purchase until only 30% of the carbs remain. It’s not easy to determine how many carbs each product has, therefore, all of my recipes always use the full amount of carbs when displaying nutrition facts.

Fermented cod liver oil (you can get it here) is a cold-pressed oil made from cod liver. It’s rich in vitamins such as fat-soluble A, D, E and K and omega-3 fatty acids. Fat-soluble vitamins are often scarce in modern diets and fermented cod liver oil is one of the best natural sources of these. It’s great for skin health, hormone balance and mental health. Vitamin D supplements have been reported to impair sleep and cause insomnia, so never take them before bed but rather with breakfast or lunch.

Why should I soak nuts and seeds?

Soaked nuts have more health benefits than raw nuts. You may want to try it before you roast them. They are better digested and the nutrients are better absorbed. While roasting helps to reduce the phytic acid, the inhibitor you want to eliminate, soaking nuts beforehand is more effective.

Soaking nuts is simple: Place them in a bowl filled with water and leave at room temperature overnight. Drain and spread on a baking sheet lined with parchment paper and place in the oven (130-150 F / 55-65 C) or in a dehydrator for 12-24 hours, turning occasionally, until completely dry. You can prepare any nuts and have them ready to eat. Store in an airtight container. Depending on which nuts you use, you should soak them for 6-12 hours. Cashews are soft and will only require minimum time, while almonds will take 8-12 hours.

How about nitrates in bacon, are they safe?

Bacon has gained a bad reputation in mainstream media. There are three main reasons: saturated fat, sodium and nitrates. You can read more about this here: 3 Reasons Why You Shouldn’t Fear Bacon. It doesn’t mean you should eat bacon every day, but as long as your diet is rich in antioxidants, you can have bacon in moderation.

Health Concerns

Many Physicians / GPs / Dietitians are against low-carb diets, why?

You will surely meet many physicians advising you against low-carb diets. There could be many reasons for it. Many physicians lack training and knowledge when it comes to nutrition. Also, they have been told the old “low-fat truth” and most of them accept it without examining recent research. Most of them are unfamiliar with the low-carb approach and oppose it before they even understand it. Finally, offering advice that opposes the generally accepted guidelines for nutrition is not a popular approach and comes at a price. Sceptics are often surprised by the patient’s weight loss and overall improved health. If your doctor is against a low-carb approach, you should consider finding another one.

Sadly, there is strong evidence that past fraudulent studies lead us to the current status quo of what a “balanced diet” should be. This video explains Ancel Keys’s well-known manipulated study from the 1950’s that formed the foundation for the current food pyramid guidelines.

What are the health benefits of ketogenic diets?

Apart from using ketogenic and other low-carb diets for weight loss, there are several health benefits people have achieved following this approach. I have written more about it in this post: Health Benefits of Low-Carb Diets. Here are other articles related to this topic:

  • Expert’s Insight: Is a Very Low-Carb Ketogenic Diet Healthy?
  • Expert’s Insight: Appetite Control and Caloric Intake on Low-carb Ketogenic Diets
  • Ketogenic Diet and Cancer – Coconut Oil or Snake Oil?

Great news!! Recently, we started cooperating with Dr Eugene Fine and his amazing team. Dr Fine is the leading expert in the effects of the ketogenic diet on cancer. We created a special build of our KetoDiet app that his team is using in their current study!

KetoDiet iPad app

Is ketosis dangerous?

No, there isn’t clinical evidence to support such a claim. Many confuse ketosis, which is safe, with ketoacidosis which is an indicator of serious health problems. Note that in the case of ketoacidosis, as it occurs in Type I diabetics and alcoholics, the level of ketones in the bloodstream is 3-5 times higher than in nutritional ketosis. Also, the level of glucose in case of ketoacidosis is very high. The two are not even comparable.

Aren’t high-fat diets unhealthy? Isn’t eating so much fat going to make me fat?

Actually, a high fat diet is healthier for you, but only when carbohydrate consumption is kept low. In most cases, a diet high in clean saturated and monounsaturated fats and low in carbohydrates raises your HDL (“good”) cholesterol and lowers your triglycerides. These two factors are really the true measure of good heart health. It also all depends on what kind of fats you consume – you have to avoid trans fats and processed fats of any kind. You can read more about oils & fats here: Complete Guide to Fats & Oils on Low-Carb Ketogenic Diet.

Fat does not make you fat. This is one of the biggest myths and unfortunately, many “healthy diets” are based on it. Fat doesn’t make you fat unless you combine it with high-carbohydrate foods. In the long run, you will realize that eating more fat, adequate protein and less carbs is the best approach for controlling your weight. Eating high fat foods will easily sate your appetite and you won’t feel hungry like you did for all those days of calorie counting and low-fat, high-carb diets. This doesn’t mean you should base your diet exclusively on sausages and bacon. Ketogenic diets are about adopting a healthier lifestyle, avoiding processed food and eating clean.

However, there may be cases in which people following a very low-carb ketogenic diet show extremely high cholesterol levels. Although many studies show no correlation between cholesterol and heart disease, some experts claim that very high cholesterol may increase the risk of heart disease. Only because there is no definite proof, it doesn’t mean that eating unlimited amount of saturated fat is safe for everyone, especially not for those suffering from hypercholesterolemia.

Although most people won’t experience extremely high levels of cholesterol, there are a few people who do (20-30%). Whether it’s down to genetics or other factors is still unclear, especially on a low-carb diet. Franziska Spritzler, a registered dietitian specialising in low-carb diets, has a brilliant article on her website and I recommend you all read it. In case your cholesterol is very high, coconut oil may be one of the foods you will have to limit.

Is it safe to lose weight quickly?

Firstly, don’t confuse the initial reduction in weight due to water loss with actual fat loss. Your body metabolizes fat slowly and takes time for it to burn fat (1-2 lb a week on average). So, it is unlikely any quick weight loss reflects actual fat loss. It will more likely be either water or muscle tissue. To avoid that make sure you consume sufficient amount of nutrients, especially protein. To find your ideal macronutrient intake, try our online keto calculator, KetoDiet Buddy. As usual, I suggest you opt for “moderate” or “slow” fat loss options.

According to Atkins, losing weight could only be an issue if:

  • You’re not eating enough and as a result of that lose lean muscle mass rather than fat. You mustn’t feel hungry and if you do between the meals, make sure you have a snack with you all the time.
  • You feel sick, dizzy or fatigued. Make sure you drink enough water and have a sufficient intake of electrolytes (sodium, magnesium, potassium).
  • you are pregnant – you should not try to lose weight during this time. Check this FAQ for details.

I have a high BMI, is it unhealthy?

Not necessarily. BMI (Body Mass Index) is calculated using your height and weight. Traditionally, BMI of 25 and more is regarded as “overweight”, while those of 30 and more are deemed “obese”. This makes it unreliable, as BMI does not take into account the percentage of body fat. So, it says nothing about body composition: the BMI of a muscular athlete could be the same as that of an overweight sedentary person, which completely misleading.

Even if your BMI is high due to high body fat, it doesn’t necessarily mean you are at risk or unhealthy. It has been proven that people with more body fat, especially at a higher age, have a lower rate of mortality compared to those with lower body fat. This could be explained by their better ability to fight serious diseases when the body has some “extra storage”. It also depends on where the fat is stored. If you have a lot of visceral fat (round your stomach area), you may be at a much higher risk. This is because visceral fat is stored where all the internal organs are and could affect their function.

If your aim is to lose weight and be healthy, you may not even need to lose as much as you may have thought. Make sure you have regular check-ups and blood tests to see the actual health effects of your diet.

Most people want to lose a lot of fat simply for esthetic reasons – this may have no additional health benefits and it will be harder to reach. Anything below the body’s “natural weight”, which is always individual, will be more difficult. But if anything, ketogenic diets are the best tool to achieve your goals!

I have high cholesterol, is it unhealthy?

Not necessarily. Contrary to what you’ve probably heard, cholesterol is absolutely vital for our body and the role of it has been completely misunderstood. The real cause of heart disease is not high cholesterol but chronic inflammation. Have a look at my post here: The Obesity Epidemic, the Truth about Cholesterol and Saturated Fat.

However, I’d like to give you an update the above post regarding saturated fat. The truth remains that only because something hasn’t been proven harmful, it doesn’t mean it’s 100% safe. You should not aim for high cholesterol only because it hasn’t been proven harmful. You can read more about high cholesterol levels on a ketogenic diet in this article by Franziska Spritzler. Along with Dr Volek and Dr Phinney, she also suggests that the majority of your fat intake should come from heart-healthy MUFA.

Here is my personal take: I’ve been following this way of eating for almost three years and noticed that some people tend to swing from one extreme to another. Many go from a very low-fat, high-carb diet to a LCHF diet without paying attention to the source of their fat intake. A healthy low-carb diet should not be based on just bacon, sausages, eggs and cheese. You should make sure to include sources of healthy fats (avocados, nuts, coconut oil) and healthy foods rich in micronutrients (non-starchy vegetables, berries, etc.).

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Does ketogenic diet cause vitamin and mineral deficiency? Do I need to take supplements?

Some people are concerned with vitamin and mineral deficiencies, as this is a common risk when you go on a calorie-restricted diet. However, studies have shown that on a relative scale of 1000 calories, a low-carbohydrate diet provides a higher level of nutrients compared to low-calorie diets. Any diets will be lacking in nutrients if you tend to eat the same food all the time. Try to make your daily plan rich and include a variety of foods (meat, vegetables, yogurt, nuts, healthy oils, etc.) and always keep an eye on your nutrients, especially electrolytes (sodium, magnesium, potassium).

I personally take vitamin D (cod liver oil), magnesium and sometimes also add selenium and zinc (thyroid health). Here is a list of supplements I’d recommend on a LCHF diet.

Do I need to take fiber supplements? How about constipation?

No, you don’t. This problem occurs when the LCHF diet is misunderstood. You cannot eat just meat and eggs, as some of you may have imagined. And you don’t get fiber just from grains and fruit. There is plenty in vegetables, some low-carb fruits or even nuts. Once these are included in the diet, fiber is not an issue. If you are still worried about lack of fiber, some types of a sugar-free fiber supplement may help you. KetoDiet iPad app calculates your daily intake of fiber so you can keep track of it and avoid any issues.

If you suffer from constipation, here are some tips:

  • Drink water! Make sure you stay hydrated (~ 2-3 liters a day)
  • Make sure your mineral intake is sufficient. You may have to increase your sodium intake, especially during the first few days of your diet. Also, try magnesium citrate – it helps with constipation.
  • Eat good fats: nuts, seeds, avocados, coconut oil, etc.
  • Try MCT oil
  • Make sure you don’t eat too much protein
  • Get a sugar-free fiber supplement like psyllium only if needed
  • Be more active, go for a walk

How is it with ketogenic diet, liver and kidney failure / gallstone disease?

The main concern is the increased occurrence of kidney stones and kidney damage due to the “high-protein” nature of ketogenic diets. Firstly, it’s a myth that ketogenic diets are high in protein. Even if they were, it’s arguable whether or not there are any negative effects. There is little research data to suggest any negative effect of ketogenic diets on kidney function or kidney stones in healthy individuals. Only people with kidney problems need to be alert and make sure they discuss any diet changes with their doctor. According to studies, a low-carb, high-fat diet has beneficial effects and may improve gallstone disease.

A secondary concern is often raised against the potentially bad effects of ketogenic diets on the liver. In studies that have been performed to examine the short-term effects, low-carb diets have been found to cause no damage to the liver in healthy individuals. In fact, diet deficient in cholesterol leads to conditions such as Non-Alcoholic Fatty Liver Disease and the ketogenic diet may actually improve this condition. Again, people with kidney disease should discuss this approach with a health professional.

What is a very low-carb diet? Is it suitable for everyone?

A very low-carb diet (VLC) typically refers to a diet that is very low in carbohydrates. Although there is no general consensus, this could vary from virtually “zero-carb” to about 50 grams of total carbs / 20 grams of net carbs. There are several reasons for which it may be beneficial to follow this strict regime. VLC may help with the treatment of some health conditions but it may also be the most effective tool for weight loss, especially for those with metabolic syndrome issues.

One of the examples of VLC is the Restricted ketogenic diet, which is a diet used for patients with serious diseases such as cancer, Alzheimer’s and epilepsy. For cancer treatment, the net carb intake could be as low as 12 grams per day while also limited in calories. In his report, Dr Seyfried gives practical advice on how to follow such diet and what results have been achieved so far.

If you follow a VLC, you have to pay close attention to what you eat, as you may lack certain micronutrients. Long-term deficiencies could lead to potential health issues. Some of the commonly deficient minerals in VLC diets are magnesium, calcium and potassium. Make sure you include foods from this list in your everyday diet. Other vitamins and minerals to be aware of are vitamin E, A, C, iron, thiamin, folate and zinc.

Does the ketogenic diet cause thyroid issues?

As I mentioned above, not everyone can follow a VLC. Some people may simply do better on a low to moderate carbohydrate diet. The only way to find out is to try it yourself and find the level at which you feel comfortable and still manage to lose or maintain your weight. Some studies show that VLC may negatively affect thyroid function and lead to a decreased level of the T3 hormone. On the other hand, they also show that 50 grams of carbohydrates a day is sufficient for higher T3 levels. The T3 hormone is known as the “metabolically active” hormone and is produced by the conversion of the “metabolically inactive” T4 hormone (by the deiodinase system). Low levels of T3 may lead to a decreased Basal Metabolic Rate (BMR), slower fat loss, hair loss, temperature regulating issues and fatigue.

Some of the arguments against low-carb diets say that we need glucose for the conversion of T4 to T3 hormone. According to low-carb experts Dr Volek and Dr Phinney, our body needs a very small amount of glucose to convert the T4 into T3. In fact, our body can make enough glucose from protein and even from fat stores via gluconeogenesis. According to studies, calorie restriction and prolonged fasting are the major dietary causes of decreased T3 levels.

However, no studies have taken individuals with preexisting thyroid issues into account and more research needs to be done to determine the long-term effects of very low-carb diets on thyroid. Although following a VLC diet may not be an issue in healthy individuals, it may negatively affect those who already have a thyroid disease. If you are one of them, make sure you get frequently tested and monitor all the changes.

Could a ketogenic diet cause hair loss?

Some of the frequently asked questions is whether low-carb eating causes hair loss as it appears to be an issue in some people. Sometimes this can be caused by rapid weight loss which is only temporary. It can also be caused by lack of dietary protein: remember that you should eat 0.6-1 gram of protein for every kilogram of lean body mass. Another reason for hair loss can be an autoimmune disease, especially hypothyroidism – make sure you get proper treatment. You can improve your hair by taking vitamins and minerals or eating foods high in zinc, biotin, vitamin B12, iron, magnesium and vitamin E.

Here is an interesting experiment where two men lived on fat and protein only for the whole year and their hair got thicker.

Is the keto diet suitable for kids?

Yes, it is. Babies and kids thrive in ketosis. In fact, the ketogenic diet is widely used to manage diseases such as autism and epilepsy in kids.

Is the keto diet safe during pregnancy and breastfeeding?

Yes, it is but you shouldn’t try to lose weight during this period. Significant weight loss during pregnancy & breastfeeding may have an adverse effect on the fetus / baby because fat cells may release toxins. Make sure you also discuss this with your doctor. To read more about ketosis during pregnancy, have a look at Maria Emmerich’s post here.

Can type 2 diabetics follow the ketogenic diet?

Yes they can. However, they have to be monitored by their doctor. They may need an adjustment to the medication after just a few days of following a low-carb diet. Together with many experts in low-carb nutrition and diabetes management, doctor Richard D Feinman has authored a review of studies that is worth reading.

Can type 1 diabetics follow the ketogenic diet?

Yes but only under medical supervision. It’s very important that type 1 diabetics don’t get into a dangerous state called ketoacidosis (very high levels of ketones and glucose).

What is the lowest body fat % that is still healthy?

You should never go below the essential body fat. Essential body fat is vital fat mass you cannot lose and it’s 8-12% for women and 3-5% for men.


Can vegetarians or vegans do ketogenic diet?

Yes, they can. However, there is a big difference between being a vegetarian and a vegan. While it’s relatively easy to be on a vegetarian, ketogenic diet, it’s very hard and nearly impossible to be on a vegan, ketogenic diet plan.

Being a vegetarian: Since the main source of quality protein on a ketogenic diet is meat, you’ll have to find alternatives. There are plenty of options like nutrient-dense eggs and dairy and even some vegetables like broccoli. In fact, you may not even need to take additional supplements. You just need to make sure you get enough vitamin B12 and iron. Apart from meat and fish, B12 is commonly found in cheese and eggs, while iron is found in nuts and dark green vegetables (watercress, spinach, kale, broccoli, etc.).

You can find all my vegetarian recipes here.

Being a vegan: Following a ketogenic diet may be hard for several reasons. In general, it will be difficult to meet your daily calories and adequate food intake. To up your calorie intake, you will need to use plenty of coconut oil, olive oil and other healthy fats. You will also likely be eating more carbs than those who can eat meat and other animal sources.

You can include nuts. To avoid eating too much omega-6 fatty acids, which are pro-inflammatory in large amounts, you will have to be careful with most nuts. Macadamia nuts, which are the healthiest option, mostly contain heart-healthy monounsaturated fats and omega 3 fatty acids. You should also eat avocados – if possible on a daily basis. They are great sources of monounsaturated fats, magnesium and potassium.

There are vitamins and minerals that are only found in animal sources and you will need to take supplements. These are vitamin B12, D3 and DHA (type of omega-3 found in fatty fish). Vitamin B12 is crucial for our body to be able to make red blood cells, nerves, DNA, and carry out other functions, while deficiency of vitamin D may result in all sorts of diseases (depression, cardiovascular disease, cancer, etc). While there are plant sources of vitamin D (D2), the most effective one is found in animal sources (D3). The importance of DHA has been discussed in this post. Other micronutrients found exclusively in animal sources are creatine and carnosine, both of which are beneficial for us, especially our brain.

Additionally, vegans are often deficient in calcium. Apart from animal sources, this vital micronutrient is found in healthy foods like dark leafy greens (kale, turnip greens), seaweed (nori sheets and other), nuts (especially almonds, sesame seeds and sesame products (unsweetened tahini) and blackstrap molasses. Also, have a look at my post to find out why B12-fortified products may not be enough in order to meet your B12 targets: Vitamin B12 Deficiency – the Masking Effect of Folic Acid.

You can find all my vegan recipes here.

The KetoDiet Apps currently offer some vegetarian and a few vegan meals and we are working hard to expand the selection of these meals even more.

How about eating at work? Can I eat in restaurants?

Office / traveling / restaurants

There is always a choice. You can avoid eating too many carbs by eating meat dishes such as steaks (with no starchy gravy or sauce), salads (again choose greens, meat, eggs based salad) with oil or mayonnaise as dressing or even some appetizers such as Parma ham with rocket or baked peppers with goat cheese. Avoid ketchup and use mustard instead. Occasionally, you can have a glass of dry wine. If you can’t avoid eating carbs, the best thing to do is to go for a walk after the meal to help burn the excessive carbs instead of storing them as fat. Don’t feel bad for having special requirements at a restaurant – you are the customer. Ask your waiter to make a special meal by adding or removing some of the ingredients. Be careful about dressings, as they may contain sugar or flour. It’s always better to ask for the dressing to be served separately instead of mixed with the food.

If you love Indian cuisine, go for meat-based curry or tikka dish with vegetables. Try Korma, Tandoori or any meat-based meals. Avoid Dahl or any lentils, potatoes and rice. Also avoid meals like Vindaloo, as it is almost impossible to eat without rice or naan bread – it’s too hot for most people.

If you love Italian cuisine, order either a meat-based meal, or fish and seafood, or anything with non-starchy vegetables (steamed, grilled, fried or fresh). Some Italian restaurants serve omelets, Italian sausages and various salads. Avoid breadcrumbs and starchy sauces in salads. Instead of sweet dressing, ask for extra virgin olive oil, balsamic vinegar or mayonnaise.

Japanese cuisine is based on seafood and rice. You can get sashimi or egg omelets. Just avoid rice!

German cuisine is quite high in carbs, but there are still meat-based delicious dishes such as Tartar steak. Avoid eating any meals with bread! Other dishes you may try are sausages or sauerkraut. However, sausages may not be the healthiest choice, as they are full of preservatives, so eat them sparingly.

Avoid noodles and get either a meat-based meal without sugary sauces or get a salad.

Greek cuisine is great for a low-carb diet. It offers a variety of fish, seafood and delicious meat-based dishes. Just avoid fries, pita bread and sweets. You can get some more ideas from my post here: Top 15 Low-Carb Meals to Try in Greece.

Must Read:  In Depth Look At Ketogenic Diets And Ketosis

Kebabs are served in bread but you can get them just with vegetables. Mayonnaise is allowed but beware of sugar that is sometimes added to it – don’t be afraid to ask.

Even Chinese food could be low in carbs. Try crispy duck and avoid the sweet sauce it is often served with. Seafood or fish soups without noodles are also an option. Apart from these, any egg or meat-based meal with non-starchy vegetables is ok – just avoid corn or too much of carrot.

You have to avoid tortillas. Avoid beans and opt for salads or meat-based meals.


Take-away doesn’t always mean junk food. Nowadays, there are many healthy alternatives such as sushi, kebabs and more. Jimmy John’s (US only) serves sandwiches without bread but wrapped in lettuce instead!

No time

If you don’t have time to cook, it’s always good to have quick snacks to replace your meal. Always have nuts, avocados at hand or try full-fat plain yogurt, berries with cottage cheese, home-made protein bars, home-made halva and other low-carb snacks. Also, you may want to try ready-made meals from Natural Ketosis.

Family and social life

This is one of the most difficult aspects of any diet. Your family, friends or colleagues may occasionally urge you to eat the wrong type of food. Most people have been taught their entire life that is best to eat whole meal bread or a low-fat yogurt. Another myth that most people believe is that cardio exercise is ideal for weight loss. Don’t be surprised even if your doctor advises you that a low-carb diet is harmful. Most doctors have been exposed to the low-fat “campaign” for decades.

Big Fat Lies is a short and entertaining video that will explains the issues with conventional approaches. Keep in mind that some people are impossible to convince no matter how strong the evidence is – it should not be your aim. In the end, this is your personal choice and you have nothing to prove to anyone. It will not take long before they realize how wrong they were!

What is the minimum amount of carbohydrates I should eat?

Many wonder if it’s actually safe to be on a VLC diet, such as 20 grams of net carbs or less per day. Is it good for you not to eat any carbohydrates when your body, especially your brain, needs it in the form of glucose? The answer is simple: our body doesn’t need carbohydrates from food consumed at all. It can make glucose from protein using a process known as gluconeogenesis. It has been estimated that about 200 grams of glucose can be generated daily just from protein (Dr. John Briffa, Escape the Diet Trap, chapter 14, 2012). If you use the KetoDiet iPad app, I encourage you to specify your weight and body fat percentage. Eating too much of protein may even disrupt ketosis and have an impact on your weight loss. Instead, your body uses ketones, a product of incomplete breakdown of free fatty acids (FFA) in the liver. The main purpose of ketones is to replace glucose as a fat-derived fuel for the brain.

You can read more about carbs in my posts here: All You Need to Know About Carbs on Low-Carb Ketogenic Diet and How Many Carbs per Day on Low-Carb Ketogenic Diet? and Total Carbs or Net Carbs: What Really Counts?

Should I count total carbs or net carbs? What is the difference?

Net carbs are Total carbs without fibre. Which ones should you track on a low-carb, ketogenic diet? It depends what your aim is. If you simply want to lose weight, you will achieve great results by counting net carbs. For therapeutic purposes you may have to count total carbs. You can read more about it in my post here: Total Carbs or Net Carbs: What Really Counts?

Are carbs on TKD going to put me out of ketosis?

People on Targeted Ketogenic Diet (TKD) are being advised to consume easily digestible carbs with high Glycemic Index (GI). These may put you out of ketosis but only for a short period provided you burn all of them during your workout session.

However, recent studies show that the need for carbs before workouts may not be necessary. In fact, extra carbs before exercise may impair keto-adaptation and performance. I suggest you read The Art and Science of Low Carbohydrate Performance. The authors, Dr Phinney and Dr Volek, argue that athletes perform better in keto-adaptation. As with everything, people have different needs and different preferences and what works for you may not work for others. Some people simply do better with some more carbs. Try and see how you feel with no carbs – keep in mind it will take about a month before you get keto-adapted. Until then, take it easy with your workouts.

If you want to avoid carbs, try coconut oil instead. Coconut oil is the best source of MCTs (Medium Chain Triglycerides), which are easily digestible, less likely to be stored by your body and are used for immediate energy. Research also shows that MCTs are thermogenic and therefore great fat-burners. For more, check out this blog post. You can read more about different types of ketogenic diets here: Types of Ketogenic Diets and the KetoDiet Approach.

How to satisfy the ketogenic diet sweet tooth?

When you start a ketogenic diet, it may be a bit tricky for you to give up sweets and starchy foods. The first few weeks are going to be difficult, as you have to exclude not only sweets but also much of the fruits and foods like bread, pasta, potatoes and rice. Your body could be addicted to sugar and it will demand it back. Below are some tips for you to successfully overcome the cravings for sweets:

Get rid off all the sweets and “banned” food. If you keep them in your fridge or cupboard, chances of cravings are much higher. Make sure you are not surrounded by foods rich in carbs. Don’t feel sorry, just bin it or give it to someone! Avoid anything containing sugar (even honey and fruits), at least for the first few weeks. Fruit and most low-carb sweets like these should be avoided at least for the first few weeks. To make life easier until you adjust to your new diet, use “zero-carb” sweeteners, like stevia, erythritol, monk fruit powder etc.

How do I get rid of the keto diet bad breath?

The ketogenic “fruity” breath doesn’t bother everyone following a ketogenic diet. To avoid this, drink a lot of water, mint tea and make sure you eat foods rich in electrolytes. Avoid too many chewing gums and mints, as they may put you out of ketosis; there may be hidden carbs affecting your blood sugar. Once you get keto-adapted, the keto breath will go away.

Is it ok to eat more protein than fat?

No, you should stay within the keto diet limits. If you are physically active, you will need more protein. This doesn’t mean your diet should transform to protein-based. Ketogenic diets are based on fat and you should try to maintain a ratio of:

  • 60-75% of calories from fat (or even more)
  • 15-30% of calories from protein, and
  • 5-10% of calories from carbs.

Note that significantly more protein may put you out of ketosis while too little protein will cause hunger issues and potentially loss of muscle mass. You can find your macronutrient targets here: KetoDiet Buddy

What may put me out of ketosis?

Apart from sugar, sugary drinks, sweeteners and grains, here is what may kick you out of ketosis:

  • fruit
  • starchy vegetables (carrot, celery root, sweet potatoes, etc.)
  • lack of physical activity together with extra carbs
  • artificial sweeteners or caffeine (exceptionally for some of you)
  • too much protein – find out your ideal protein intake using our online keto calculator!

More ketones, more fat loss?

This has been discussed in my post here: Ketosis & Measuring Ketones. Simply said, unless you have health reasons for it (Restricted Ketogenic Diet), I wouldn’t advise you to aim for “zero-carb” eating. Most people experience all the great fat loss and health benefits of the Ketogenic diet at 20-30 grams of net carbs per day.

In fact, you don’t need to be in ketosis to lose weight. As always, some people achieve great results on low-moderate carbohydrate diets, while others do well on a very low-carb diet. Simply said – you have to try what works best for you. If you want to know more about ketone levels and their effect on fat loss, have a look at this post: Do Ketones Matter?

What if I can’t lose weight? Reaching the weight loss plateau

I have covered this very common issue extensively in my post here. In short:

  • Get macros are right – check our online keto calculator, KetoDiet Buddy. Take the results as guidelines and don’t worry if you don’t meet your targets exactly. In any case, your daily energy requirements will fluctuate on a daily basis.
  • Make sure you get your daily electrolytes (sodium, magnesium and potassium)
  • Try following my 30-Day Clean Eating Challenge (weekly meal plan included). In this challenge, you will avoid foods that are known to be causing weight stalling (dairy, low-carb treats).
  • Follow some of my diet plans – they may help you stick with the diet and break through a plateau.
  • Include some exercise. Make sure you don’t do too much cardio-based exercise. Focus on strength training & high-intensity interval training (HIIT).
  • If nothing seems to be working, try the fat fast (guide with meal plan included) or intermittent fasting

Do I have to exercise to lose weight?

The good news is that for losing body fat, you don’t need to exercise. However, exercise can help you lose weight in many ways:

  • Strength training / lifting weights or using your own body weight. It will help you lose weight by building muscles and slightly increasing your basal metabolic rate.
  • Using the HIIT (HIIE) technique. Unlike prolonged cardio training, high intensity intermittent exercise (high intensity interval training) will help you burn more calories without increasing your appetite.
  • Moderate cardio such as walking or light cycling are beneficial for your health and can help you stay focused and positive. However, studies show that this type of exercise doesn’t seem to have any long-term benefits for weight loss per se.
  • Here is our guide to exercise that will help you make the right choices.

Do I have to get my exercise in all at once? No, you don’t have to. Studies have shown that a continuous exercise has the same benefits as exercise that is split up into smaller periods throughout the day. This means you can have a shorter morning and evening exercise routines that will benefit the same, as if you did all at once.

You can read even more about protein, carbs and exercise nutrition in these posts: How to Exercise on a Keto Diet, Ketogenic Nutrition and Exercise: Protein and Ketogenic Nutrition and Exercise: Carbs

Do I need to eat carbs before my workouts?

No, once you get keto-adapted, you body will not need extra glucose and will be using ketones and fat for energy. However, you may need to add carbs for explosive exercise actions. You can read more about carbs and exercise here:

  • All You Need to Know About Carbs on a Low-Carb Ketogenic Diet
  • Types of Ketogenic Diets and the KetoDiet Approach
  • Keto Diet Nutrition & Exercise: Carbs

You can read even more about carbs and exercise nutrition in this post: Ketogenic Nutrition and Exercise: Carbs

How important is sleep for weight loss?

Lack of sleep may be behind your weight stalling. It may sound as cliche but sleep is an absolutely crucial part of fat loss: Maximum fat loss is only achieved with adequate sleep, diet and exercise. Try to fall asleep before midnight and sleep for 7-9 hours. Also, try to go to bed at 10 pm or latest before midnight. If you stay up too late, your body will produce cortisol which will slow down fat loss.

Is it harmful or beneficial to have carb up days / cheat days every now and then?

When it comes to “cheat days”, people often wonder if they are beneficial for faster fat loss. Most claim to use this strategy to break through a weight loss plateau. However, there is no general rule and the effects vary for individuals. The reasons some people include cheat days are two. Firstly, it helps them to break through a weight loss plateau and secondly for motivational purposes to help them adhere to the diet.

Here is what happens if you include a cheat day. Initially, when you start following a low-carb diet, your glycogen levels go down and you lose water. If you include a cheat day, you may feel like you have put on weight due to water retention. When you go back to a healthy low-carb diet, you will notice an immediate effect. Although some physically active individuals use “carb up days” in between their workouts to stimulate muscle growth, you won’t need carb-ups if you mostly do weight training and moderate HIIT.

Can I do intermittent fasting?

Yes, you can but you should not attempt it for the first 4 weeks of the ketogenic diet. Your body needs to get keto-adapted first.

Can I do fat fasting?

Yes, but only after you get keto-adapted and if you need to break through a weight loss plateau. You can read all about the fat fast here.

Can I build muscles on the keto diet?

Yes you can build muscles due to the muscle-sparing effect of ketogenic diets. You can read more in an excellent book by Dr Volek and Dr Phinney The Art and Science of Low Carbohydrate Performance

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